How we use the Real Work Opportunities Programme at Priory

By Laura Murphy, Therapy Services Manager, Chris Jones, Technical Instructor, Charlotte Hearn, Senior Occupational Therapist, and Caroline Knight, Lead Consultant Neuropsychologist and Acting Clinical Director for Brain Injury Services. The authors work at The Priory Burton Park, a specialist neuropsychiatry service.

The history of the Real Work Opportunities Programme

The Real Work Opportunities Programme (RWO) was originally devised to explore meaningful vocational occupation for people within a forensic learning disabilities population. Cox et al (2014)* noted that often, patients lacked the optimum skills to allow them to be ‘work ready’, and therefore, developed a 12-week programme to assist people in gaining these relevant skills.

The programme considered:

• Ethical issues such as ensuring that people received payment for work completed
• Risk and those detained under the Mental Health Act, which limited their opportunities for community access
• Setting up job roles that simulate the real work process

The RWO Programme allowed people to have access to the skills, tools and support to best prepare them to gain either employment or voluntary work as part of their inpatient stay or after discharge.

The RWO Programme supports patients to complete conventional pre-employment tasks, including completing a CV, applying for the role, being interviewed, and if successful, completing any relevant training. The patient is then gradually given more responsibility as the RWO Programme progresses. At the end of the programme, patients can add their work experience to their CV and use supervising staff as referees. Examples of current active roles include:

• Grounds keeper
• Vehicle maintenance technician
• Patient liaison link
• Animal care coordinator

Neurobehavioural rehabilitation

Priory Brain Injury Services have modified and introduced a bespoke RWO Programme over the last three years. Priory Brain Injury Services offers rehabilitation, care and support to people with an acquired brain injury (ABI) and to those with progressive neurological conditions (PNCs).

Neurobehavioural rehabilitation services are available at The Priory Burton Park, in Leicestershire and The Priory Grafton Manor, in Northamptonshire. These specialist sites offer treatment to those with challenging behaviour related to neurobehavioural disabilities that arise from the common consequences of ABI. The disabilities include complex, often subtle and long lasting cognitive and behavioural changes.

RWO Programme amendments for Brain Injury Services patients

Modification of the RWO Programme has been made so that it is specific to the needs of people with ABI or PNCs:

• Physical disabilities are prevalent within this population and therefore roles and environments were adapted to make them accessible
• For one patient who is undertaking the vehicle maintenance role, standalone steps were provided to assist them to get in and out of the vehicle and adapted tools were provided to ease their ability to reach into the vehicle
• Another patient with a quiet voice was given a microphone headset to amplify their voice in their training role
• The whole programme was amended to last for a longer period of time (24 weeks) to cope with the cognitive challenges, such as retaining and embedding new skills, that are common for this population
• Prompts and reminders that could be gradually phased out were built in where relevant. One patient initially failed to rise from his bed for work but the member of staff working with him gradually set expectations to increase independence, until he was able to meet at the right time and place ready for work
• Feedback given at two-weekly intervals in the original programme proved to be difficult to accept for some. Therefore, on-the-spot feedback was provided, which patients were more likely to relate and respond to, due to memory limitations
• Roles were created that were person centred; this was done by considering the interests of the patients, the skills relevant to their goals, or drawn from their long term, well established and procedurally learnt skills

Our programme goals – integrity, fairness and innovation

The RWO Programme has been audited annually to ensure integrity, fairness and innovative practice and development. Many positive outcomes have been found. Examples include:

• ‘G’, who would not engage in any previously offered therapy and appeared only interested in seeking illegal drugs, channelled his interests into growing vegetables
• ‘M’, who spent time frequently screaming, showed dramatically reduced levels of this when she commenced her role as a trainer
• ‘L’, who successfully gained a liaison role in representing the views of his peers in meetings, reported that he found doing things for other people fulfilling

In the last two years, 11 different work roles were created and 19 patients actively engaged in the roles. One person successfully gained a voluntary position in the community following the programme and another returned to paid employment. One person presented the programme, with staff, at several external conferences and another returned as an outpatient to continue his role post discharge into the community.

Patient comments about the RWO Programme: 

 “It gets me off the ward.”

“I know I can’t go back to (my old job) and this is helping me start over again.”

“I enjoy working alongside (staff).”

“These are everyday skills in the real world.”

“Something to help me get better and engage in work when I leave, to help get employment.”

“More things to do.”

“Something to help others.”

Commissioner and family member comments:

“Amazed to see how well (he) is engaged in comparison to when I last saw him.”

“Perfect as it helps occupy their mind.”